The healthcare provider (HCP) prescribes methylergonovine for a postpartum client following the birth of her third child.
The client asks the practical nurse (PN), "Why am I getting these tablets? I did not get them with my last babies.”. Which response is best for the PN to provide?
Bleeding with the delivery of this baby is more than expected, and this medication helps contract the uterus.
The HCP routinely prescribes this medication for all women who have had three or more infants.
Methylergonovine is commonly prescribed to help contract the uterus and prevent excess bleeding.
What did the HCP say about the medications during postpartum care?
The Correct Answer is A
Choice A rationale
Methylergonovine is an ergot alkaloid that directly stimulates sustained uterine contractions. This action is crucial in controlling postpartum hemorrhage by compressing blood vessels within the myometrium, thereby reducing blood loss. The observed excessive bleeding with this delivery necessitates intervention to prevent complications like hypovolemic shock. Its pharmacological effect targets smooth muscle receptors in the uterus.
Choice B rationale
Routine prescription based solely on parity (number of previous pregnancies) is not standard medical practice. Methylergonovine is administered based on clinical indication, primarily to prevent or manage postpartum hemorrhage, which is determined by factors like uterine atony or excessive bleeding, not simply the number of previous births. Unnecessary administration can lead to adverse effects.
Choice C rationale
While methylergonovine does contract the uterus and prevent excess bleeding, this response is a general statement. The best response directly addresses the client's current situation and her question about why *she* is receiving it *this time*. It is crucial to explain the specific clinical reason for her individual prescription, which in this context is likely due to the increased bleeding.
Choice D rationale
This response shifts the responsibility back to the client and does not provide the requested information. It fails to address the client's direct question about the medication's purpose in her specific situation. Providing clear and concise information is essential for client education and adherence to the treatment plan.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
Collecting a urine specimen for electrolytes and protein would not directly address the client's acute symptoms of restlessness and apprehension. While important for general assessment, these lab parameters are not the primary indicators of fetal distress or immediate maternal physiological deterioration in this context. Normal electrolyte ranges: sodium 135-145 mEq/L, potassium 3.5-5.0 mEq/L. Protein in urine is usually negative.
Choice B rationale
Moving the client into a dorsal recumbent position can actually exacerbate vena caval compression in a laboring client at 42-weeks gestation, potentially leading to supine hypotensive syndrome, which would worsen rather than alleviate restlessness and apprehension due to decreased cardiac output and uteroplacental perfusion.
Choice C rationale
Encouraging the client to push with the next contraction is inappropriate given her symptoms of restlessness and apprehension. These symptoms could indicate evolving complications, such as hypoxemia or even early stages of hypovolemic shock, requiring immediate assessment of vital signs and fetal well-being before encouraging active labor efforts.
Choice D rationale
Providing information about the baby's status can help alleviate the client's apprehension, especially if her symptoms are related to anxiety about the labor process or fetal well-being, which is common in intrapartum fever. Scientific rationale supports addressing psychological distress to improve coping mechanisms.
Correct Answer is B
Explanation
Choice A rationale
Administering ibuprofen may alleviate pain temporarily, but it does not address the underlying cause of increased pain and pressure, which could indicate a developing complication such as a perineal hematoma. Providing only symptomatic relief delays investigation and potential intervention for a serious issue.
Choice B rationale
Increased pain and pressure in the vaginal area following a perineal laceration, especially 6 hours postpartum, are classic signs of a developing perineal hematoma. This condition requires prompt medical evaluation by the healthcare provider to assess the extent of bleeding, potential for shock, and determine the need for surgical intervention.
Choice C rationale
Applying an icepack to the perineum is a common comfort measure for swelling and pain associated with lacerations. While it may provide some relief, it will not resolve a developing hematoma or significant internal bleeding that is causing increased pain and pressure. It is an insufficient intervention for the potential severity of the client's symptoms.
Choice D rationale
Providing routine perineal care, such as gentle cleansing and hygiene, is important for comfort and infection prevention. However, it does not address the acute and increasing pain and pressure that suggests a complication beyond typical postpartum discomfort. This intervention would delay necessary medical assessment for a potential hematoma.
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